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Honors programs and similar initiatives aimed at evoking excellence of students are increasingly promoted in higher education. However, there is a lack of conceptual clarity with regard to the concept of 'student excellence'. The purpose of this article is to present a conceptual framework, called FACE (Framework for Analyzing Conceptions of Excellence), which provides a reflective tool for analyzing ideas on who is excellent, what is student excellence, why is student excellence important, and how is excellence taught. The content of FACE is based on literature on giftedness, motivation and excellence in higher education. FACE consists of a horizontal axis with inclusive and exclusive views at the extremes, and vertically distinguishes between possible answers to the 'who'-, 'what'-, 'why'- and 'how'-questions. FACE as a reflective tool can facilitate constructive debate among teachers that work together to develop educational programs aimed at evoking excellence of students. [ABSTRACT FROM AUTHOR]

An in vivo range verification technology for proton beam cancer therapy, preferably in real-time and with submillimeter resolution, is desired to reduce the present uncertainty in dose localization. Acoustical imaging technologies exploiting possible local interactions between protons and microbubbles or nanodroplets might be an interesting option. Unfortunately, a theoretical model capable of characterising the acoustical field generated by an individual proton on nanometer and micrometer scales is still missing. In this work, such a model is presented. The proton acoustic field is generated by the adiabatic expansion of a region that is locally heated by a passing proton. To model the proton heat deposition, secondary electron production due to protons has been quantified using a semi-empirical model based on Rutherford's scattering theory, which reproduces experimentally obtained electronic stopping power values for protons in water within 10% over the full energy range. The electrons transfer energy into heat via electron-phonon coupling to atoms along the proton track. The resulting temperature increase is calculated using an inelastic thermal spike model. Heat deposition can be regarded as instantaneous, thus, stress confinement is ensured and acoustical initial conditions are set. The resulting thermoacoustic field in the nanometer and micrometer range from the single proton track is computed by solving the thermoacoustic wave equation using k-space Green's functions, yielding the characteristic amplitudes and frequencies present in the acoustic signal generated by a single proton in an aqueous medium. Wavefield expansion and asymptotic approximations are used to extend the spatial and temporal ranges of the proton acoustic field. [ABSTRACT FROM AUTHOR]

Shear wave elastography (SWE) has the potential to determine cardiac tissue stiffness from non-invasive shear wave speed measurements, important, e.g., for predicting heart failure. Previous studies showed that waves traveling in the interventricular septum (IVS) may display Lamb-like dispersive behaviour, introducing a thickness-frequency dependency in the wave speed. However, the IVS tapers across its length, which complicates wave speed estimation by introducing an additional variable to account for. The goal of this work is to assess the impact of tapering thickness on SWE. The investigation is performed by combining in vitro experiments with acoustic radiation force (ARF) and 2D finite element simulations, to isolate the effect of the tapering curve on ARF-induced and natural waves in the heart. The experiments show a 11% deceleration during propagation from the thick to the thin end of an IVS-mimicking tapered phantom plate. The numerical analysis shows that neglecting the thickness variation in the wavenumber-frequency domain can introduce errors of more than 30% in the estimation of the shear modulus, and that the exact tapering curve, rather than the overall thickness reduction, determines the dispersive behaviour of the wave. These results suggest that septal geometry should be accounted for when deriving cardiac stiffness with SWE. [ABSTRACT FROM AUTHOR]

Background: The potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-to-day contact with patients. This study's aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for APM, with needs and expectations of HCW. Methods: Qualitative semi-structured interviews were held with sixteen HCW (i.e. physicians, residents and nurses) from high-risk AMR departments at a regional hospital in The Netherlands. Deductive coding was succeeded by open and axial coding to establish main codes, subcodes and variations within codes. Results: HCW demand insights from audits into all facets of APM in their working routines (i.e. diagnostics, treatment and infection control), preferably in the form of simple and actionable feedback that invites interdisciplinary discussions, so that substantiated actions for improvement can be implemented. AF should not be seen as an isolated ad-hoc intervention, but as a recurrent, long-term, and organic improvement strategy that balances the primary aims of HCW (i.e. improving quality and safety of care for individual patients and HCW) and AMR-experts (i.e. reducing the burden of AMR). Conclusions: To unlock the learning and improvement potentials of audit and feedback, HCW' and AMR-experts' perspectives should be balanced throughout the whole AF-loop (incl. data collection, analysis, visualization, feedback and planning, implementing and monitoring actions). APM-AF should be flexible, so that both audit (incl. collecting and combining the right data in an efficient and transparent manner) and feedback (incl. persuasive and actionable feedback) can be tailored to the needs of various target groups. To balance HCW' and AMR-experts' perspectives a participatory holistic AF development approach is advocated. [ABSTRACT FROM AUTHOR]

Shear wave elastography (SWE) might allow non-invasive assessment of cardiac stiffness by relating shear wave propagation speed to material properties. However, after aortic valve closure, when natural shear waves occur in the septal wall, the stiffness of the muscle decreases significantly, and the effects of such temporal variation of medium properties on shear wave propagation have not been investigated yet. The goal of this work is to fundamentally investigate these effects. To this aim, qualitative results were first obtained experimentally using a mechanical setup, and were then combined with quantitative results from finite difference simulations. The results show that the amplitude and period of the waves increase during propagation, proportional to the relaxation of the medium, and that reflected waves can originate from the temporal stiffness variation. These general results, applied to literature data on cardiac stiffness throughout the heart cycle, predict as a major effect a period increase of 20% in waves propagating during a healthy diastolic phase, whereas only a 10% increase would result from the impaired relaxation of an infarcted heart. Therefore, cardiac relaxation can affect the propagation of waves used for SWE measurements and might even provide direct information on the correct relaxation of a heart. [ABSTRACT FROM AUTHOR]

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Abstract: Many researchers use Cronbach's alpha to demonstrate internal consistency, even though it has been shown numerous times that Cronbach's alpha is not suitable for this. Because the intention of questionnaire and test constructers is to summarize the test by its overall sum score, we advocate summability, which we define as the proportion of total test variation that is explained by the sum score. This measure is closely related to Loevinger's H. The mathematical derivation of summability as a measure of explained variation is given for both scale and dichotomously scored items. Using computer simulations, we show that summability performs adequately and we apply it to an existing productive vocabulary test. An open‐source tool to easily calculate summability is provided online ( https://sites.google.com/view/summability). [ABSTRACT FROM AUTHOR]

Background: Cashew nut, pistachio nut and mango belong to the Anacardiaceae family and are botanically related. Therefore, cashew nut sensitised children are frequently advised to eliminate cashew nuts and pistachio nuts from their diet. The 'Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572) study showed that cashew nut sensitised children were co-sensitised to pistachio nut in 98% of cases and to mango in 21% of cases. The aim of this follow-up study to IDEAL is to assess the clinical relevance of co-sensitisation to pistachio nut and mango in cashew nut sensitised children. Methods: Children were recruited from the study: 'Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572). Inclusion criterion for the IDEAL study was sensitization to cashew nut as demonstrated by either SPT or sIgE, and a clinical history of reactions to cashew nuts or no previous (known) exposure. Sensitized children who were tolerant to cashew nuts were excluded. Inclusion criterion for this IDEAL follow-up study was co-sensitization to pistachio nut, regardless the result of the DBPCFC with cashew nut. In this follow-up study a double-blind placebo-controlled food challenge with pistachio nut and an open food challenge with mango were performed. Results: Twenty-nine children (mean age of 11.6 years, 62% male) were included. Pistachio nut sensitisation was clinically relevant in only 34% of cashew-sensitised children and only 31% of cashew challenge positive children. None of the children was challenge positive to mango. Conclusion: Although co-sensitisation between cashew nut and pistachio nut was observed in 98%, pistachio nut sensitisation was only clinically relevant in 34% of the children. Therefore, a challenge test with pistachio nut is recommended in children with cashew nut and pistachio nut sensitisation. [ABSTRACT FROM AUTHOR]

Introduction: Maastricht University has been actively exploring blended learning approaches to PBL in Health Master Programs. Key principles of PBL are, learning should be constructive, self-directed, collaborative, and contextual. The purpose is to explore whether these principles are applicable in blended learning. Methods: The programs, Master of Health Services Innovation (case 1), Master Programme in Global Health (case 2), and the Master of Health Professions Education (case 3), used a Virtual Learning Environment for exchanging material and were independently analyzed. Quantitative data were collected for cases 1 and 2. Simple descriptive analyses such as frequencies were performed. Qualitative data for cases 1 and 3 were collected via (focus group) interviews. Results: All PBL principles could be recognized in case 1. Case 2 seemed to be more project-based. In case 3, collaboration between students was not possible because of a difference in time-zones. Important educational aspects: agreement on rules for (online) sessions; visual contact (student–student and student–teacher), and frequent feedback. Conclusion: PBL in a blended learning format is perceived to be an effective strategy. The four principles of PBL can be unified in PBL with a blended learning format, although the extent to which each principle can be implemented can differ. [ABSTRACT FROM AUTHOR]

Unlabelled: Here, we summarise the current clinical knowledge on Ara h 6 sensitisation and clinical relevance of this sensitisation pattern using five illustrative clinical cases. The literature search yielded a total of 166 papers, and an additional relevant article was found by 'snowballing'. A total of ten articles were considered relevant for this review. Most studies included patients with a sensitisation to Ara h 6 and cosensitisation to Ara h 2. Only three studies showed patients with a mono-sensitisation to Ara h 6. This illustrates that Ara h 6 mono-sensitisation has been neglected in literature. We present a case series of five children with sensitisation to peanut component Ara h 6. Only one of these five patients showed Ara h 8 cosensitivity. Three out of the five children had a positive double-blind placebo-controlled food challenge (DBPCFC), with moderate to strong reactions.Conclusion: A mono-sensitisation to peanut component Ara h 6 is uncommon but can cause severe allergic reactions. Therefore, the determination of sIgE to Ara h 6 is warranted in patients with a suspected peanut allergy, especially in the absence of sensitisation to Ara h 1, 2, 3 and 9.What Is Known: • Peanut allergy is common and can cause severe allergic reactions. • The diagnostics of peanut allergy has recently improved with the use of component resolved diagnosis What is new: • A mono-sensitisation to peanut component Ara h 6 is uncommon, but can cause severe allergic reactions • Determination of sIgE to Ara h 6 is warranted in patients with a suspected peanut allergy, especially in the absence of sensitisation to Ara h 1, 2, 3 and 9. [ABSTRACT FROM AUTHOR]

Background: There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histaminesensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in doubleblind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods. Methods: Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEPindex area) were compared in a Receiver-Operating Characteristic (ROC) plot. Results: Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEPindex area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC. Conclusions: The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC. [ABSTRACT FROM AUTHOR]

ABSTRACT The use of stem cells for the repair of damaged cardiac tissue after a myocardial infarction holds great promise. However, a common finding in experimental studies is the low number of cells delivered at the area at risk. To improve the delivery, we are currently investigating a novel delivery platform in which stem cells are conjugated with targeted microbubbles, creating echogenic complexes dubbed StemBells. These StemBells vibrate in response to incoming ultrasound waves making them susceptible to acoustic radiation force. The acoustic force can then be employed to propel circulating StemBells from the centerline of the vessel to the wall, facilitating localized stem cell delivery. In this study, we investigate the feasibility of manipulating StemBells acoustically in vivo after injection using a chicken embryo model. Bare stem cells or unsaturated stem cells (<5 bubbles/cell) do not respond to ultrasound application (1 MHz, peak negative acoustical pressure P_ = 200 kPa, 10% duty cycle). However, stem cells which are fully saturated with targeted microbubbles (>30 bubbles/cell) can be propelled toward and arrested at the vessel wall. The mean translational velocities measured are 61 and 177 μm/s for P- = 200 and 450 kPa, respectively. This technique therefore offers potential for enhanced and well-controlled stem cell delivery for improved cardiac repair after a myocardial infarction. Biotechnol. Bioeng. 2015;112: 220-227. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This study assessed the relation of an impaired taste and smell perception with (a) potential determinants and (b) nutritional intake and status in elderly people. Determinants examined were age, gender, functional category (institutionalized vs independently living), dental state, illnesses, smoking behavior, drug usage, and saliva excretion and composition. Nutritional intake and status were measured by an "appetite and hunger" questionnaire, a food frequency questionnaire, and body mass index (BMI). In order to have access to a large heterogeneous group, two different categories of elderly people were studied. We enrolled independently living elders (n=89) assumed to have a relatively good taste and smell perception, and institutionalized elders (n=67) with a potential poorer taste and smell perception. Scores at the smell identification (range: 0-10) and taste perception (range: 0-4) test were, respectively, 5.7 (independently living) versus 3.5 (institutionalized); p < .0001 and 3.3 versus 3.0; p < .05. Correlation between smell test scores and outcomes of the "appetite and hunger" questionnaire ranged from r: .19 to .50; p values < .05. There was, however, no clear correlation of any sensory outcome with energy and food intake, nor with BMI. Regression analyses revealed that age and the functional category were the most important determinants of the scores on the taste perception and smell identification tests. It is concluded that a poor performance on sensory tests is related to a poor appetite but not necessarily to low energy intake or low BMI. Age-related factors and smoking are important determinants of impaired sensory functioning. [ABSTRACT FROM AUTHOR]